KeepEX, a simple dilution protocol for improving extracellular vesicle yields from urine.

Urinary extracellular vesicles (EVs) are a promising source of biomarkers, which can be obtained in a non-invasive manner. However, the yield of EVs from urine samples may be insufficient for various analyses due to the entrapment of EVs by the Tamm-Horsfall protein (THP) meshwork. Here, we developed a simple dilution protocol to increase the urinary EV yield by disrupting the interaction between THP filaments and EVs with the help of alkaline pH and lowered ionic concentration. The integrity of the EVs and THP was assessed by electron microscopy. The effect of the protocol on the EV yield was quantified against an undiluted control by western blotting of four EV markers, nanoparticle tracking analysis and measuring of the RNA/miRNA concentration of the EV samples. The average EV yield from the dilution protocol was 2-7 fold the yield from the undiluted control i.e. increased by 130-624% as measured by western blotting and NTA. The yield increased most from samples with a high THP to EV ratio. The morphology and size range of the EVs were unaltered by the protocol. However, RNA/miRNA yields were the same as from the undiluted control and THP filaments could still be detected in EV samples. The dilution protocol, that we named KeepEX, provides a simple and efficient way to prevent loss of EVs thus increasing their yield from urine. Since KeepEX does not require individual adjustment of sample pH nor extra centrifugation steps, it could be used on its own or in combination with other EV purification protocols to improve EV isolation particularly from small urine volumes.

Longitudinal associations between physical activity and depression scores in Swedish women followed 32 years.

OBJECTIVE: Physical activity is negatively associated with depressive symptoms. However, few studies consider dynamic associations of changes in physical activity and reciprocal relationships. This study aimed to perform comprehensive evaluations of relationships between physical activity and depression scores in women followed from mid- to late life. METHOD: The Prospective Population Study of Women in Gothenburg, Sweden, provided repeated measures of self-reported physical activity and depressive symptoms between 1974 and 2005 (baseline N = 676, 84.5% response rate). Depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale, and physical activity was evaluated by the Saltin-Grimby Physical Activity Level Scale. Latent growth curve analyses were used to evaluate associations of change, and cross-lagged models were used to study the reciprocal relationship between physical activity and depression scores. RESULTS: At baseline, lower levels of physical activity were related to higher depression scores. Individuals with decreasing physical activity over time evidenced higher depression scores at 32-year follow-up. Higher average baseline depression score was related to declining levels of physical activity at subsequent examinations. CONCLUSION: Reduced physical activity may be a long-term consequence of depression. It is important to address individual changes in physical activity and not merely absolute levels of physical activity in relationship to depression.

A 37-year prospective study of neuroticism and extraversion in women followed from mid-life to late life.

OBJECTIVE: Personality traits are presumed to endure over time, but the literature regarding older age is sparse. Furthermore, interpretation may be hampered by the presence of dementia-related personality changes. The aim was to study stability in neuroticism and extraversion in a population sample of women who were followed from mid-life to late life. METHOD: A population-based sample of women born in 1918, 1922 or 1930 was examined with the Eysenck Personality Inventory (EPI) in 1968-1969. EPI was assessed after 37 years in 2005-2006 (n = 153). Data from an interim examination after 24 years were analysed for the subsample born in 1918 and 1922 (n = 75). Women who developed dementia at follow-up examinations were excluded from the analyses. RESULTS: Mean levels of neuroticism and extraversion were stable at both follow-ups. Rank-order and linear correlations between baseline and 37-year follow-up were moderate ranging between 0.49 and 0.69. Individual changes were observed, and only 25% of the variance in personality traits in 2005-2006 could be explained by traits in 1968-1969. CONCLUSION: Personality is stable at the population level, but there is significant individual variability. These changes could not be attributed to dementia. Research is needed to examine determinants of these changes, as well as their clinical implications.

Retarded head growth and neurocognitive development in infants of mothers with a history of eating disorders: longitudinal cohort study.

OBJECTIVE: To characterise early growth and neurocognitive development in children of mothers with a history of eating disorders (ED). DESIGN: A longitudinal cohort study. SETTING: Child-care centres in Stockholm, Sweden. POPULATION: Children born to mothers with previous ED (n = 47) (24 anorexia nervosa, 20 bulimia nervosa, 3 unspecified ED), and controls (n = 65). METHODS: Mean values and standard deviation scores of weight and height from birth to 5 years of age and head circumference up to 18 months of age were compared between groups. Neurocognitive development was studied at the age of 5 years by the validated parent questionnaire Five to Fifteen. MAIN OUTCOME MEASURES: Head growth and neurocognitive development. RESULTS: We previously reported that mothers with a history of ED conceived infants with lower birthweight and head circumference than controls. At 3 months of age, body mass index (BMI) was no longer reduced but mean head circumferences of the children born to mothers with ED were smaller throughout the observation period. Similarly, the longitudinal results of the standard deviation scores of head circumference showed a significant overall group effect with lower levels in both subgroups of ED (anorexia nervosa and bulimia nervosa). The children of the ED mothers also had significantly higher Five to Fifteen scores than controls, reflecting difficulties in language skills. Head circumference at birth correlated with language skills in the children of mothers with ED. CONCLUSION: Children of mothers with previous ED demonstrated an early catch-up in BMI, but the average head circumference continued to be delayed until at least 18 months of age. The reduced head growth was related to delayed neurocognitive development.

Gray matter volume alterations related to trait dissociation in PTSD and traumatized controls.

OBJECTIVE: This study used voxel-based morphometry (VBM) to investigate brain structural alterations related to trait dissociation and its relationship with post-traumatic stress disorder (PTSD). METHOD: Thirty-two subjects either developing (N = 15) or non-developing (N = 17) PTSD underwent MRI scanning and were assessed with the Dissociative Experience Scale (DES), subscales for pathological (DES-T) and non-pathological trait (DES-A) dissociation, and other clinical measures. Gray matter volume (GMV) was analyzed using VBM as implemented in SPM. PTSD and non-PTSD subjects were compared to assess brain alterations related to PTSD pathology, whereas correlation analyses between dissociation measures and GMV were performed on the whole sample (N = 32), irrespective of PTSD diagnosis, to identify alterations related to trait dissociation. RESULTS: As compared to traumatized controls, PTSD subjects showed reduced GMV in the prefrontal cortex, hippocampus and lingual gyrus. Correlations with dissociation measures (DES, DES-T, and DES-A) consistently showed increased GMV in the medial and lateral prefrontal, orbitofrontal, parahippocampal, temporal polar, and inferior parietal cortices. CONCLUSION: PTSD and dissociation seem to be associated with opposite volumetric patterns in the prefrontal cortex. Trait dissociation appears to involve increased GMV in prefrontal, paralimbic, and parietal cortices, with negligible differences between pathological and non-pathological dissociation.

Self-rating scales assessing subjective well-being and distress correlate with rCBF in PTSD-sensitive regions.

BACKGROUND: The aim of this study was to investigate the distribution of the regional cerebral blood flow (rCBF) in occupational-related post-traumatic stress disorder (PTSD) subjects and to seek possible correlations between brain perfusion and self-rating scales (SRS) in order to cross-check their diagnostic value and to look for their neural correlates. METHOD: A total of 13 traumatized underground and long-distance train drivers developing (S) and 17 not developing (NS) PTSD who had experienced a 'person under train' accident or who had been assaulted at work underwent clinical assessment and 99mTc-HMPAO SPECT imaging during autobiographical trauma scripts. Statistical parametric mapping was applied to analyse rCBF changes in S as compared with NS and to search for correlations between rCBF and the administered SRS scores, modelling age, months to SPECT and the ratio 'grey matter/intra-cranial volume' as nuisance variables. RESULTS: Significantly higher activity was observed during trauma script in left posterior and anterior insula, posterior cingulate, inferior parietal lobule, precuneus, caudate and putamen in PTSD subjects as compared with the trauma-exposed control group. Impact of Event Scale and World Health Organisation (10) Well-Being Index scores highly correlated with tracer uptake to a great extent in the same regions in which rCBF differences between S and NS were found. CONCLUSIONS: These findings support the involvement of insular, cingulate and parietal cortices (as well as the basal ganglia) in the pathogenesis of PTSD and in the processing of related subjective well-being and distress.

Trimer stability of YadA is critical for virulence of Yersinia enterocolitica.

Yersinia adhesin A (YadA) is a trimeric autotransporter adhesin with multiple functions in host-pathogen interactions. The aim of this study was to dissect the virulence functions promoted by YadA in vitro and in vivo. To accomplish this, we generated Yersinia enterocolitica O:8 mutants expressing point mutations in YadA G389, a highly conserved residue in the membrane anchor of YadA, and analyzed their impact on YadA expression and virulence functions. We found that point mutations of YadA G389 led to impaired transport, stability, and surface display of YadA. YadA G389A and G389S mutants showed comparable YadA surface expression, autoagglutination, and adhesion to those of wild-type YadA but displayed reduced trimer stability and complement resistance in vitro and were 10- to 1,000-fold attenuated in experimental Y. enterocolitica infection in mice. The G389T, G389N, and G389H mutants lost trimer stability, exhibited strongly reduced surface display, autoagglutination, adhesion properties, and complement resistance, and were avirulent (>10,000-fold attenuation) in mice. Our data demonstrate that G389 is a critical residue of YadA, required for optimal trimer stability, transport, surface display, and serum resistance. We also show that stable trimeric YadA protein is essential for virulence of Y. enterocolitica.

Infrequent use of antidepressants in depressed individuals (an interview and prescription database study in a defined Swedish population 2001-2002).

PURPOSE: To investigate whether antidepressants are over-used, under-used, or misused, by determining to what extent the depressed individuals in a defined population are treated with antidepressant medication and, from the other end, to what extent prescribed antidepressants are aimed for the treatment of depression. SUBJECTS AND METHOD: From an individual based prescription database in the County of Jämtland, 2048 individuals representative for the general population were selected. The presence of current depression in these individuals was screened by a mailed self-screening questionnaire. Individuals with depression according to the questionnaire were interviewed by a psychiatrist using a structured interview (SCAN) to confirm the diagnosis. Their use of antidepressants was obtained from the prescription database. RESULTS: Sixty-two (4.5%) out of 1375 were diagnosed with depression and 17 (27%) of these were taking an antidepressant. In addition 44 individuals, currently not depressed, were taking antidepressants. Twenty-five of these were interviewed per telephone and it was found that the indications for 18 of them were continuation treatment of depression, and for seven of them pain, sleep disturbance or anxiety. CONCLUSION: Antidepressants appear to be under-used in the population. Only one in four of the depressed individuals was treated with antidepressant medication. Those who had antidepressant medication without being currently depressed had, with few exceptions, either continuation treatment for depression in remission or treatment on other approved indications.

A short-term cognitive group treatment program gives substantial weight reduction up to 18 months from the end of treatment. A randomized controlled trial.

OBJECTIVE: To describe and evaluate long-term efficacy (18 months from the end of treatment) of a new cognitive short-term weight reducing treatment program for obese patients. SUBJECTS: One hundred and five obese [Body Mass Index (BMI) > or = 30] patients participated in the study. Of these, 62 took part in the treatment program and 43 served as controls. METHOD: From an obesity unit's waiting list, the patients were randomly assigned to either a treatment group or remained in the waiting list to serve as a control group. The treatment group participated in a 10-week (30 hours) cognitive group treatment program. All participants were weighed at the outset of the study, directly after treatment and at a 6-, 12- and 18-month post-treatment follow-up without any booster treatment after the 10-week program. RESULTS: Fifty-seven (92%) patients completed treatment. For the 34 (60%) patients who participated in the study 18 months after treatment was terminated, the mean weight loss at treatment's end was 8.5 kg (SD=16.1). Eighteen months later their mean weight loss was 10.4 kg (SD=10.8). The control patients (n=31.72%) that participated in the study during the same period increased in weight by 2.3 kg (SD=7.0). The weight difference between the treatment and control group at the 18-month follow-up was highly significant (p<0.001). CONCLUSION: The cognitive group treatment program was highly acceptable among the participants and was completed by nearly all the patients. The 10-week treatment program resulted in satisfactory weight loss. The weight difference between the treatment group and controls was nearly the same at 18 months after end of treatment as at six months. The study, therefore, does not provide support for the contention that a lengthy therapy for obesity is necessary if treatment results are lasting.

The significance of addressing trauma in outpatient psychiatry.

Establishing post-traumatic stress disorder as a psychiatric diagnosis has only marginally increased awareness of traumatic experiences. Traumas are inconsistently recorded in initial psychiatric histories and, when observed, rarely reflected in the primary diagnosis and treatment. The present study aimed to investigate if there is an association between sufficiently addressing trauma and long-term outcome and what factors affect whether trauma, according to the patient's view, is sufficiently addressed or not. Socio-demographic data, experiences of trauma and treatment, and outcome, were collected retrospectively from Arabic, Iranian, Turkish and Swedish patients, who had visited a psychiatric clinic 3-4 years earlier. Fifty-one patients whose traumatic experiences had been sufficiently addressed were compared with 39 patients who perceived that their traumas had not been addressed. Logistic regression analyses were performed to examine relationships between clinical variables and whether or not traumas had been addressed. Patients with trauma sufficiently addressed reported high confidence in staff (odds ratio, OR=7.2, p<0.001), high self-rated health (OR=8.0, p<0.01) and low scores on the Self-rating Inventory for PTSD (OR=7.7, p<0.05) and Depression Scale (OR=3.0, p<0.15). Reporting less than five different traumas (OR=4.6, p<0.01) and being an ethnic Swede (OR=2.4, p<0.10) were the background variables independently related to having trauma sufficiently addressed. Addressing trauma may improve patients' confidence in staff, self-rated health and trauma-related symptoms. Multiplicity of traumas and belonging to an ethnic minority implied that trauma was less addressed.

Alterations of rCBF and mitochondrial dysfunction in major depressive disorder: a case report.

OBJECTIVE: A mitochondrial disease might be considered when depressive disorder is associated with diabetes mellitus or other symptoms commonly found in mitochondrial disease. Scattered regional cerebral blood flow (rCBF) decreases and increases have been reported in depressive and mitochondrial disorders. A 61-year-old male patient with early adult onset of depressive disorder and a slowly developing multiorgan syndrome including diabetes mellitus was investigated. METHOD: 99mTc-HMPAO rCBF SPECT and muscle biopsy to assess mitochondrial functions were performed in the patient. RESULTS: Alterations of rCBF were found in the patient, with the most pronounced decreases in the left dorsolateral frontal and inferior parietal lobes, and the most pronounced increases in the bilateral superior parietal lobes. Muscle biopsy revealed myopathy and decrease of mitochondrial adenosine triphosphate production rates (MAPRs). CONCLUSION: The MAPRs decreases support the suspicion of mitochondrial dysfunction in the patient. A subgroup of depressed patients may have mitochondrial dysfunctions.

Alexithymia, social support, psycho-social stress and mental health in a female population.

BACKGROUND: We wanted to look into what impact the level of alexithymia, as assessed by the Toronto Alexithymia Scale with 20 items (TAS-20), has on presence of social support and vulnerability for psycho-social stress assessed as occurrence of serious life-events, in an all-female population. METHODS: A total of 1032 of females employed in a child-care programme in Sweden participated. They were asked to fill in a questionnaire and 864 (83.6%) delivered complete tests. RESULTS: The prevalence of alexithymia was 7.9% and there were significant associations between high TAS-20 scores with low level of education. In addition, this assessment showed significant relationships between global TAS-20, as well as the sub-factors of TAS-20 and lower social support. Having a low level of social support was found to be 3.5 times more common in the part of the population who was alexithymic. It was also 2.6 times more common for the alexithymic part of the population not to have someone to turn to. Alexithymics with low support and no life events had overall mean scores on all the three variables presenting them as worse off from a mental health point of view. When life events were present alexithymics remained worse off than non-alexithymics even when a higher level of support was in place. There was a significant direct protective (salutary) effect of social support found for social disability in the alexithymic population. CONCLUSION: Alexithymics in this study showed a lack of social support and a proneness to high levels of negative emotion and to social distress.

Differences in resting state regional cerebral blood flow assessed with 99mTc-HMPAO SPECT and brain atlas matching between depressed patients with and without tinnitus.

An increased occurrence of major depressive disorder has been reported in tinnitus patients, and of tinnitus in depressive patients. Involvement of several Brodmann areas (BAs) has been reported in tinnitus perception. The aim of this study was to assess the regional cerebral blood flow (rCBF) changes in depressed patients with and without tinnitus. The rCBF distribution at rest was compared among 45 patients with a lifetime prevalence of major depressive disorder, of whom 27 had severe tinnitus, and 26 normal healthy subjects. 99mTc-hexamethylenepropylene amine oxime (99mTc-HMPAO) single photon emission computed tomography (SPECT), using a three-headed gamma camera, was performed and the uptake in 34 functional sub-volumes of the brain bilaterally was assessed by a computerized brain atlas. Decreased rCBF in right frontal lobe BA 45 (P<0.05), the left parietal lobe BA 39 (P<0.00) and the left visual association cortex BA 18 (P<0.05) was found in tinnitus patients compared with non-tinnitus patients. The proportion of tinnitus patients with pronounced rCBF alterations in one or more of the temporal lobe BAs 41+21+22 was increased compared to gender matched controls (P<0.00) and patients without tinnitus (P<0.05). Positive correlations were found between trait anxiety scales from the Karolinska Scales of Personality and rCBF in tinnitus patients only in three limbic BAs (P<0.01), and inverse correlations in non-tinnitus patients only in five BAs subserving auditory perception and processing (P<0.05). rCBF differences between healthy controls and depressed patients with and without tinnitus were found in this study. The rCBF alterations were distributed in the cortex and were particularly specific in the auditory cortex. These findings suggest that taking audiological symptoms into account may yield more consistent results between rCBF studies of depression.

Dental anxiety in relation to mental health and personality factors. A longitudinal study of middle-aged and elderly women.

Little is known about the longitudinal course of dental anxiety in relation to age, mental health and personality factors. In 1968 69 a representative sample of 778 women aged 38 to 54 yr took part in a psychiatric examination. Three hundred and ten were followed up in 1992-93. A phobia questionnaire, including assessment of dental fear, and the Eysenck Personality Inventory were distributed to the participants at both occasions. High dental fear was reported by 16.8% of the women at baseline and was associated with a higher number of other phobias, a higher level of neuroticism, more psychiatric impairment, more social disability due to phobic disorder, and a higher anxiety level. Among women who reported high dental fear in 1968 69 (n=36), 64% remitted and 36% remained fearful. Among women with low dental fear in 1968 69 (n = 274), 5% reported high dental fear in 1992-93. Chronicity was associated with higher neuroticism, lower extraversion, and more psychiatric impairment at base-line. Remission was associated with higher extraversion at baseline. Dental anxiety increased or decreased over time in concert with the number of other fears.

Coordinate control of sphingolipid biosynthesis and multidrug resistance in Saccharomyces cerevisiae.

Multiple or pleiotropic drug resistance often occurs in the yeast Saccharomyces cerevisiae through genetic activation of the Cys(6)-Zn(II) transcription factors Pdr1p and Pdr3p. Hyperactive alleles of these proteins cause overproduction of target genes that include drug efflux pumps, which in turn confer high level drug resistance. Here we provide evidence that both Pdr1p and Pdr3p act to regulate production of an enzyme involved in sphingolipid biosynthesis in S. cerevisiae. The last step in formation of the major sphingolipid in the yeast plasma membrane, mannosyldiinositol phosphorylceramide, is catalyzed by the product of the IPT1 gene, inositol phosphotransferase (Ipt1p). Transcription of the IPT1 gene is responsive to changes in activity of Pdr1p and Pdr3p. A single Pdr1p/Pdr3p response element is present in the IPT1 promoter and is required for regulation by these factors. Loss of IPT1 has complex effects on drug resistance of the resulting strain, consistent with an important role for mannosyldiinositol phosphorylceramide in normal plasma membrane function. Direct assay for lipid contents of cells demonstrates that changes in sphingolipid composition correlate with changes in the activity of Pdr3p. These data suggest that Pdr1p and Pdr3p may act to modulate the lipid composition of membranes in S. cerevisiae through activation of sphingolipid biosynthesis along with other target genes.

[The Gothenburg study of women and alcohol: low occurrence of abuse--increase appears to have abated]. / Studie i Göteborg om kvinnor och alkohol: låg förekomst av missbruk--ökningen förefaller ha avklingat.

Prevalence of alcohol dependence and abuse (ADA) was determined in a cohort of women selected by stratified random sampling from the general population in Gothenburg. A questionnaire was administered to 3,130 women and 399 were interviewed. Questions were asked about social background, living conditions, family and working life. Volume and frequency of alcohol intake were recorded, and diagnoses were made according to DSM-III. We found that the one-year prevalence of ADA was 1.5 percent and the life time prevalence 3.3 percent. In a follow-up five years after base-line, the prevalence of ADA was unchanged, while indicators of high alcohol consumption and high episodic drinking showed reduced levels of problem drinking.

Multiple signals from dysfunctional mitochondria activate the pleiotropic drug resistance pathway in Saccharomyces cerevisiae.

Multiple or pleiotropic drug resistance most often occurs in Saccharomyces cerevisiae due to substitution mutations within the Cys(6)-Zn(II) transcription factors Pdr1p and Pdr3p. These dominant transcriptional regulatory proteins cause elevated drug resistance and overexpression of the ATP-binding cassette transporter-encoding gene, PDR5. We have carried out a genetic screen to identify negative regulators of PDR5 expression and found that loss of the mitochondrial genome (rho(o) cells) causes up-regulation of Pdr3p but not Pdr1p function. Additionally, loss of the mitochondrial inner membrane protein Oxa1p generates a signal that results in increased Pdr3p activity. Both of these mitochondrial defects lead to increased expression of the PDR3 structural gene. Importantly, the signaling pathway used to enhance Pdr3p function in rho(o) cells is not the same as in oxa1 cells. Loss of previously described nuclear-mitochondrial signaling genes like RTG1 reduce the level of PDR5 expression and drug resistance seen in rho(o) cells but has no effect on oxa1-induced phenotypes. These data uncover a new regulatory pathway connecting expression of multidrug resistance genes with mitochondrial function.

Hyperactive forms of the Pdr1p transcription factor fail to respond to positive regulation by the hsp70 protein Pdr13p.

Multidrug resistance in Saccharomyces cerevisiae is commonly associated with the overproduction of ATP-binding cassette transporter proteins such as Pdr5p or Yor1p. The Cys6-Zn(II)2 cluster-containing transcription factors Pdr1p and Pdr3p are key regulators of expression of these pleiotropic drug resistance (PDR) loci. Previous experiments have demonstrated that the Hsp70 protein encoded by the PDR13 gene is a positive regulator of Pdr1p function. We have examined the mechanism underlying the control of Pdr1p by Pdr13p. Expression of deletion, insertion and amino acid substitution mutant variants of Pdr1p suggest that the centre region of the transcription factor is the target for Pdr13p-mediated positive regulation. Immunological and fusion protein analyses demonstrate that Pdr13p is located in the cytoplasm, while Pdr1p is found in the nucleus. Biochemical fractionation experiments indicate that Pdr13p is associated with a high-molecular-weight complex and suggest the association of some fraction of Pdr13p with ribosomes.

The morality of treating patients with depot neuroleptics: the experience of community psychiatric nurses.

The aim of this qualitative study was to gain an understanding of the meaning that community psychiatric nurses impart to their everyday interactions with patients in depot neuroleptic treatment situations. Nine experienced community psychiatric nurses were interviewed using semistructured, open-ended questions. Data analysis was by the phenomenological descriptive method according to Giorgi. Four themes were identified, highlighting aspects of the moral meaning of treating patients with depot neuroleptics: (1) 'benevolent justification' occurs when nurses perceive that the patient's welfare is at stake; (2) 'inability to advocate the patients' best interest' occurs when nurses feel they are at a disadvantage; (3) 'accommodative interactions' occur when nurses are able to respond to a patient's expressed needs; and (4) 'acceptable advocacy' occurs when physicians are sensitive to nurses' suggestions on patients' treatment. The findings indicate that treatment care planning involving both patients and nurses is essential to enhance patients' autonomy, which is a precondition for satisfactory interactions. This phenomenological study describes the meaning that nurses give to administering depot neuroleptic injections to patients in the context of community psychiatric clinics. The phenomenon of concern was identified as the moral aspect in the interactions with individual patients in the treatment situation.

The first nurse-patient encounter in a psychiatric context: an initial study in an action research process.

This paper presents an initial study undertaken as the first step in action research concerning the first encounter between the nurse and the patient on psychiatric admission. The specific aim was to identify obstacles and possibilities of starting an ongoing learning process with mutual agreement upon goals and a good working relationship between the principal investigator and the participating nurses. Participant observation and questionnaires, completed by nurses and patients, were used in the data collection. The main finding was the identification of parallel processes concerning patients and nurses as to experiences of the abandonment and the lack of confirmation and autonomy. This initial study confirms the need and satisfies the requirements for continuing the action research process.